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General NPI Number Information
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NPI Number | 1770803843
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Entity Type | Organization
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Legal Business Name | 20 20 VISION, LLC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 738 PRATER WAY
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City | SPARKS
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State | NV
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Zip | 89431-4466
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Country | US
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Telephone | 775-356-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 738 PRATER WAY
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City | SPARKS
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State | NV
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Zip | 89431-4466
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | FANNY CHAN
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Credential |
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Telephone | 775-247-4351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 319
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License Number State | NV
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